Page 190 - HIV/AIDS Guidelines

Table 15a. Drug Interactions between Protease Inhibitors* and Other Drugs (Page 2 of 11)

Effect on PI or Dosing Recommendations and Clinical
Concomitant Drug PI Concomitant Drug Comments
Concentrations

ATV ↓ ATV PPIs are not recommended in patients
receiving unboosted ATV. In these patients,
consider alternative acid-reducing agents, RTV
boosting, or alternative PIs.
ATV/r ↓ ATV PPIs should not exceed a dose equivalent to
omeprazole 20 mg daily in PI-naive patients.
PPIs should be administered at least 12 hours
Proton Pump before ATV/r.
Inhibitors (PPIs)
PPIs are not recommended in PI-experienced
patients.
DRV/r, TPV/r ↓ omeprazole May need to increase omeprazole dose when
PI: no significant effect using TPV/r.
FPV +/- RTV, LPV/r No significant effect No dosage adjustment necessary.

SQV/r SQV AUC ↑ 82% Monitor for SQV toxicities.
Anticoagulants
Warfarin ATV +/- RTV, DRV/r, ↑ or ↓ warfarin possible Monitor INR closely when stopping or starting PI
FPV +/- RTV, LPV/r, DRV/r ↓ S-warfarin AUC 21% and adjust warfarin dose accordingly.
SQV/r, TPV/r

Anticonvulsants
RTV-boosted PIs
ATV/r, FPV/r, LPV/r, ↑ carbamazepine possible Consider alternative anticonvulsant or monitor
SQV/r, TPV/r TPV/r ↑ carbamazepine AUC levels of both drugs and assess virologic
26% response. Do not coadminister with LPV/r once
May ↓ PI levels substantially daily.

DRV/r carbamazepine AUC ↑ 45% Monitor anticonvulsant level and adjust dose
Carbamazepine
DRV: no significant change accordingly.
PIs without RTV
ATV, FPV May ↓ PI levels substantially Monitor anticonvulsant level and virologic
response. Consider alternative anticonvulsant,
RTV boosting for ATV and FPV, and/or
monitoring PI level.

Lamotrigine LPV/r lamotrigine AUC ↓ 50% Titrate lamotrigine dose to effect or consider
LPV: no significant change alternative anticonvulsant. A similar interaction is
possible with other RTV-boosted PIs.

Phenobarbital All PIs May ↓ PI levels substantially Consider alternative anticonvulsant or monitor
levels of both drugs and assess virologic
response. Do not coadminister with LPV/r once
daily.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-20

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